May 22, 2013

Almost Half Of COPD Diagnoses Are Wrong

A new study has found that chronic obstructive pulmonary disease (COPD) is over-diagnosed among uninsured patients.

Researchers found that over 40 percent of patients being treated for COPD at federally funded clinics did not actually have the disease. COPD is a progressive lung disease that leads to the loss of lung function and is primarily caused by smoking. The disease causes coughing, wheezing, shortness of breath, chest tightness and other symptoms. A survey published in 2003 in the journal Respiratory Medicine found the average cost of treating COPD is $4,119 per year.

"While there have been many studies of the under-diagnosis of COPD, there has not been a U.S.-based study that has quantified the problem of over-diagnosis," said Christian Ghattas, MD., MSc, a second-year medical resident at Saint Elizabeth Health Center in Youngstown, Ohio, who will present the research at ATS 2013. "And yet, the cost of treating someone for COPD is high."

The team evaluated 80 patients that had been given either a diagnosis of COPD or had been prescribed an anticholinergic inhaler, which is a therapy used to treat COPD symptoms. All 80 patients underwent spirometry testing by a trained professional following American Thoracic Society recommendations.

Researchers found that 42.5 percent of patients had no obstruction at all, indicating that they did not have COPD. Another 23 percent of patients had reversible obstruction, which is more characteristic of asthma than COPD, and only 35 percent had non-reversible obstruction.

Ghattas stated the researchers were shocked by the percentage. He added that the true rate of misdiagnosis was probably closer to half, because they did not further evaluate the 23 percent with reversible obstruction.

"This study confirms that symptoms alone are insufficient to make a COPD diagnosis," said Magdi H. Awad, Pharm.D, assistant professor of pharmacy at Northeast Ohio Medical University. "Shortness of breath, cough, and sputum production can indicate other respiratory problems like allergies — or they may be symptoms of a heart problem or of simply being overweight."

The researchers believe that studies like this should be duplicated in other settings with different patient populations.

"Although the number of patients in our study was small, I believe this study is representative of an uninsured and underserved patient population," Dr. Ghattas said, "However, the findings might be different among patients who are insured. They might be higher or lower — we simply don't know."

Ghattas and Magdi say that studies like the one they performed are likely to pay for themselves by reducing unnecessary medical expenses.

"It is obviously detrimental to be on medications that won't work for you," said Dr. Ghattas. "You won't feel better — and that by itself can take a psychological toll — and you may experience side effects that can compromise other aspects of your health."

Researchers from Boston University School of Medicine (BUSM) reported in April that they had found a genetic signature for COPD in airways cells. Their finding could lead to a new way to test for, study and treat COPD, as well as monitor patient's response to treatments.